From Big Medical Encyclopedia

INCREMENT OF THE PLACENTA — a pathological implantation of placenta, at Krom of a vorsina of chorion grow into a myometrium (muscular coat) in connection with partial or total absence of a spongy layer of the endometria participating in formation of basal department of a decidua.

Depending on penetration depth vorsin chorion in a myometrium distinguish three options of an increment of a placenta: placenta accreta, placenta increta and placenta percreta. At placenta accreta the spongy layer of basal department of a decidua is atrophied, vorsina contact to a myometrium, without being implemented into it and without breaking its structure. At placenta increta of a vorsina of chorion get into a myometrium, breaking its structure. At placenta percreta of a vorsina of chorion sprout a myometrium on all depth, up to a visceral peritoneum. At a full increment the placenta is soldered to a myometrium on all its extent, at partial — only on certain sites.

The first wedge. description of an increment placentae (see) J. Simpson (1836) possesses, the first patomorfol. the description — to Hart (V. of Hart, 1889). The Pct given about frequency considerably fluctuate that is connected by hl. obr. with imperfection of diagnosis. In cases of placental presentation (see) its increment meets more often than at a normal arrangement of a placenta.

Disturbance of process of formation of decidual fabric in the place of implantation of fetal egg is promoted its implantation in sites with fiziol. a hypotrophy of an endometria (a mucous membrane of a uterus), in the field of an isthmus or a neck of uterus, an atrophy of an endometria owing to operative measures (Cesarean section, manual department of an afterbirth, a scraping of a mucous membrane of a uterus) or pathological processes in a uterus and closed glands (the postponed metroendometritis, subserous myoma, a hypo-ovaria, etc.).

Owing to atrophic processes in an endometria in the place of implantation of fetal egg the spongy layer of a basal decidua disappears partially or completely. As a result of a vorsina of chorion appear in direct contact with a myometrium and grow into it. At gistol. a research the atrophy of a decidua, especially her spongy layer on certain sites is noted or throughout placental platform (see). Vorsina of chorion or are shipped in a myometrium on different depth, or are separated from it by accumulations of fibrinoid. Placental a septum, normal consisting of decidual fabric, are partially replaced with muscle fibers. The subject myometrium plentifully vaskulyarizirovan.

Clinically the Pct is characterized by disturbance of process of department of a placenta in the third period childbirth (see). Signs of department of an afterbirth (see. Afterbirth period ) no. At partial Pct or in attempts of its violent removal there is plentiful bleeding (see. Hypotonic bleedings ). At manual intervention the placenta comes off pieces, completely from a wall of a uterus does not separate. Emergence is possible hemorrhagic shock (see), a syndrome of the disseminated intravascular coagulation (see. Hemorrhagic diathesis ). In cases of placenta percreta in the second half of pregnancy the hysterorrhesis is possible (see. Childbirth ). The diagnosis is established in inefficient attempts of manual department of an afterbirth.

The pct is the absolute indication for urgent supravaginal amputation of a uterus (see. Uterus ) or hysterectomies (see). Along with removal of a uterus hold compensation of blood loss and an event directed to prevention of emergence of hemorrhagic shock.

Forecast serious; its timely diagnosis and an urgent operative measure improve.

Prevention consists in fight against abortions (see. Abortion artificial ), early detection and treatment puerperal diseases (see) and disturbances menstrual cycle (see).

Bibliography: E. Platsent's patter of the person, the lane with polsk., Warsaw, 1970; Gulkevich 10. Century, Makkaveev and M. 10. both Nikiforov of B. I. Patologiya of an afterbirth of the person and its influence on a fruit, Minsk, 1968; Becker G. Die spontane uterusruptur infolge von Placenta accreta, Diss., Tübingen, 1967; Bonn i-el-Veyron P. Considerations sur le placenta accreta, diss., 1967.

M of A. Repina.